2015 APPLICATIONS 7.PDF

Created Thursday, February 19, 2015
Page 1
General information
General information | Organization Southwest Human Development
General information | Contact First name Lisa
General information | Contact Last name Olivas-Cook
General information | Contact e-mail grants@swhd.org
General information | Contact phone number 602-633-8178
Address
Address | Street 2850 N 24th Street
Address | City Phoenix
Address | State AZ
Address | ZIP Code 85008
From what tribe is the organization requesting the grant?
Fort McDowell Yavapai Nation
Total grant amount request
$30000
The Gila River Indian Community offers multi-year awards. If your organization is requesting a
multi-year grant for this project or program, enter the amount to be requested each year.
Amount
Year 1 $30000
Year 2 $
Year 3 $
Year 4 $
Year 5 $
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Southwest Human Development, Inc.
ROR Program Operating Budget
7/1/2015 to 6/30/2016
Ft. McDowell Funds Annual Amount
Fort McDowell Funds $ 30,000 $ 30,000
Federal $ - $ -
State $ - $ 25,000
First Things First $ - $ 64,090
Schools $ - $ -
Contributions $ - $ -
Private Business $ - $ 70,000
Private Pay $ - $ -
Carryover $ - $ 64,148
Additional Funding $ - $ 110,974
Total Operating Revenue $ - $ 364,212
Salary $ - $ 83,639
Benefits $ - $ 21,044
Mileage $ - $ 2,908
Space Rentals $ - $ 9,688
Loc/Lng Communication $ - $ 408
Cellular Phone Service $ - $ 480
Program Supplies $ 30,000 $ 218,944
Office Supplies $ - $ 550
Training $ - $ 1,540
Overhead $ - $ 25,011
Total Operating Expenses $ 30,000 $ 364,212
Need for Philanthropic Support: While SWHD has an operating budget of over $59 million, 88%
of that represents federal, state and First Things First contracts for targeted programs and
services, primarily Head Start and Child Welfare. The Reach Out and Read budget of $364,212.00
represents .7% of the agency’s overall budget, 38% of which must be raised through private
philanthropy. Your support is vital to maintaining Reach Out and Read services in the East Valley.

Created Friday, February 20, 2015
Page 1
General information
General information | Organization ICM Food & Clothing Bank
General information | Contact First name Jacque
General information | Contact Last name Ahrenberg
General information | Contact e-mail jahrenberg@icmaz.org
General information | Contact phone number 6024994089
Address
Address | Street PO Box 2225
Address | City Phoenix
Address | State Arizona
Address | ZIP Code 85002
From what tribe is the organization requesting the grant?
Fort McDowell Yavapai Nation
Total grant amount request
$5000
The Gila River Indian Community offers multi-year awards. If your organization is requesting a
multi-year grant for this project or program, enter the amount to be requested each year.
Amount
Year 1 $
Year 2 $
Year 3 $
Year 4 $
Year 5 $
Page 1



Local Government Entity:
Maricopa County, Amanda Nash, (602) 506-4485, nasha001@mail.maricopa.gov
Organization:
ICM Food & Clothing Bank, Jacque Ahrenberg, CFRE, 602-499-4089, MAILING ADDRESS
jahrenberg@icmaz.org P.O. Box 2225
Phoenix, Arizona
ICM Food & Clothing Bank has been an integral part of the community since 1983, with 85002-2225
the mission of providing an immediate response to basic human needs for the working
PHYSICAL ADDRESS
poor, elderly, families, children, nearly homeless and disabled in Central Phoenix. We 501 S. 9th Avenue
recognize that many members of community are deeply in need of help and kindness. 4 blocks south of Jefferson
We offer emergency food and clothing, toiletries, medical services and resource
referrals. 602-254-7450
FAX 602-257-1837
www.icmaz.org
ICM meets the Fort McDowell funding priorities of health by focusing of lessening food
insecurity, economic and community development by focusing our services on helping BOARD OF DIRECTORS
those most in need to become self-sufficient and prevent homelessness. ICM requests Lucien Klejbuk
$5,000 from Fort McDowell Yavapai Nation. President
ICM Food and Clothing Bank Unique Characteristics Myra Kingsley
• 95% volunteer driven President Elect
• Only food bank open on Saturday Jason Berg
• On site medical monthly screening clinic Treasurer
• Almost entirely privately funded
• Low overhead costs (less than 6%) Susan Cervantez
Secretary
• Seeks to develop self-reliance among recipients
• Staff is hired only when programs grow too large for volunteers to handle Derek Amarillas
• Sells no items or services Manuel Amarillas III
Jan Dressel
William Hemelt
Proposed Program
Preston Jensen
Each day more than 150 families and individuals obtain free food, clothing, personal Tracy Johnson
hygiene items and medical wellness services. We work with each person or family in Carrie Macias
distress to create a unique and comprehensive care plan that draws upon ICM’s wide Don Weiss
array of free social and medical services under one roof. The warehouse and office is
located at 501 South 9th Avenue in Phoenix, Arizona. ICM STAFF
Renea Gentry, Ext. 3
Response to Basic Needs Executive Director
For over 30 years the ICM Food & Clothing Bank has worked to ease this economic Abby Loza, Ext. 4
strain by supplying food and clothing assistance to both working and nonworking Director of
families. We are here to provide a hand up to those who are doing all they can to Volunteers/Outreach
survive. While we cannot prevent financial difficulties from occurring, together we can
provide a ray of hope. Statistics show that most Americans are only a few missed Francisco Lopez Ext. 2
Director of Operations
paychecks from being homeless and in need. Our average clients report making less
than $10,000 a year; the elderly live on less than that with Social Security payments Jacque Ahrenberg, Ext. 5
only. A recent survey of clients reveled the following 57% of families go to bed hungry at Development Director
night several times a week, and 59% don’t have enough food for the family to eat at least
once a week.
Since SERVING 1983, a THE food VALLEY’S and clothing MOST bank NEEDY for the Valley’s FOR 30 most YEARS needy
www.icmaz.org www.icmaz.org

Our Process
Services are provided Monday through Saturday, on a first come first serve basis, by a staff of 5
full-time and 8 part-time individuals and 130+ member volunteer corps who give their time to
the equivalent of 9 full-time positions. We serve anyone residing in Maricopa County regardless
of their address of record. Each day, a line of 150+ hungry families in critical need of our
services are already wrapped around the building by 8:00am. On Saturdays when our medical
clinic is open, our lines are especially heavy. Each person’s introduction to ICM begins with a
personal interview and needs assessment by volunteers or our case manager, all trained to deal
with basic needs and crises. We create a unique plan of action that draws upon ICM’s wide
array of free services including a volunteer driven medical clinic, all under one roof. Services are
defined by five key areas: Emergency Food Assistance, Basic Needs, Children’s Corner,
Medical Services and Resource Referral. Each element is critical in the transition from
dependence on assistance to self-reliance for the working poor, families, children, physically
and/or mentally challenged, and the elderly.
Who We Serve
Many of us don’t think twice about where our next meal will come from, or if we’ll have shelter or
health needs met. But the people ICM serves grapple daily with these realities. On average
57% have had to choose between paying for basic utilities and buying food; 43% have had to
choose between paying for housing or buying food; and 41% percent have had to decide
whether to pay for food or medicine/health care. With businesses closing, people being laid off
from their jobs and bills mounting, good nutrition is often the first thing to cut. ICM is seeing
those who were once contributors to the agency now becoming clients instead. There is a
hunger struggle in our large urban areas, where high poverty, unemployment and food deserts
conspire to give residents fewer options to feed their families.
Our clients range from newborn to over 90; individuals to single parents to entire families;
working, unable to work and unable to find work. Of those benefiting from receiving our basic
essentials, 55% are children under 18 years old, 65% are working or needy poor, 5% are
disabled, and 20% are elderly on fixed income (many grandparents raising grandchildren).
Ethnicities served are 54% Hispanic, 31% White, 9% African American, 4% American Indian
and 2% Asian. Most of our families are one paycheck away from being homeless The day-to-
day existence and struggles of many of our area's low paid workforce and seniors on very tiny
incomes are sometimes heartbreaking and usually hidden.
Other funding
As stated before, ICM has low administrative costs, and is mostly funded by individuals,
foundations and corporations. Gila River Indian Community made a three-year commitment to
ICM’s youth nutrition program last year.
Long-term funding resources include a variety of congregations, foundations and corporations
such as U-Haul, C. Myers Corporation and SRP.
Enclosed budget

ICM Food and Clothing Bank
Financial Projections (cash basis)
For the FY 2015 Budget
Budget
FY15
Income
Individual Contributions $166,380
Corporate/Foundation Restricted $80,500
Corporate/Foundation unrestricted $121,510
Congregational contributions $26,000
Government Grants (until 6/30/15) $93,500
Special Event Fundraising $42,470
Rental Income $6,000
Clothing Sales $1,675
Total Income $537,035
Expenses
Salaries, general $339,370
Auto expenses $8,000
Bank and card fees $1,350
Building Supplies $13,690
Computer $7,700
Fundraising/Marketing $14,550
Insurance $12,900
Legal/accounting $12,960
Office Supplies $9,000
Postage/printing $9,000
Professional Development $2,000
Telephone/internet $9,760
Utilities $23,185
Volunteer Recognition $2,155
Other $400
Direct client purchases $71,015
Total Expenses $537,035
Difference $0

Created: 02/20/2015
Last updated: 04/01/2015
Page 1
General information
Organization Leukemia & Lymphoma Society
Contact First name Naomi
Contact Last name Martinez
Contact e-mail naomi.martinez@lls.org
Contact phone number 6025677612
Address
Street 3877 N 7th St Ste 300
City phoenix
State az
ZIP Code 85014
From what tribe is the organization requesting the grant?
Fort McDowell Yavapai Nation
Total grant amount request
25,000.00
The Gila River Indian Community offers multi-year awards. If your organization is requesting a multi-year grant for this
project or program, enter the amount to be requested each year.
Amount
Year 1
Year 2
Year 3
Year 4
Year 5
1 of 1



Patient Travel Assistance Program
Proposal to
Ft. McDowell Yavapai Nation
Submitted By:
The Leukemia & Lymphoma Society
AZ Chapter
3877 N. 7th Street Suite 300
Phoenix AZ 85014
www.lls.org/az

Mrs. Selena Castaneda
Tribal Council Secretary
Ft. McDowell Yavapai Nation
P.O. Box 17779
Fountain Hills, AZ 85269
Dear Mrs. Castaneda,
Please accept our deepest gratitude for your consideration of this grant request on behalf of the
patients and families who will benefit from your generosity. Please refer to the following narrative which
outlines our eligibility to be considered for the grant:
The Leukemia & Lymphoma Society (LLS) respectfully requests a grant of $25,000 from the Fort
McDowell Yavapai Nation to support the Arizona Patient Travel Assistance Program. This gift will be
100% restricted to this specific program and will aid Arizona blood cancer patient families by helping to
cover treatment-related travel and lodging expenses. LLS has recognized this as an area of unmet
need and a significant barrier to access to care for many patients. The Nation’s support will help LLS
break down this financial barrier and allow more patients to access the care they need.
LLS, a 501(c)(3) organization, is the largest not-for-profit health agency dedicated to finding cures and
better treatments for people with leukemia, lymphoma or myeloma—collectively known as blood
cancers. More than 1 million Americans are currently living with, or in remission from, a blood cancer.
Every 3 minutes someone is diagnosed with a blood cancer, with more than 155,000 new cases
expected this year
LLS recognizes that finding cures is not enough; we need to ensure that patients have access to the
treatments they need to live longer, better, healthier lives. LLS is dedicated to removing barriers to care.
LLS is the voice for blood cancer patients, working with regulatory bodies (i.e., FDA) and state and
federal legislatures to drive policies that accelerate the development and approval of innovative
treatments and ensure that patients have access to quality, affordable, coordinated care. LLS is the
leading source of free blood cancer information, education and support for patients, families and
healthcare professionals. Services include national and community-based programs including travel
assistance, co-pay assistance, clinical-trial search and peer-to-peer support. The Arizona Chapter
provides services to blood cancer patients living within the 15 counties of Arizona.
The Arizona Patient Travel Assistance Program is a new program for LLS and funds raised in Arizona
will stay in the community to help local patient families. The program provides financial assistance to
people diagnosed with a blood cancer who struggle to pay for treatment-related transportation and/or
lodging costs (e.g., parking, tolls, gasoline, plane or train tickets, temporary housing). Qualified patients
receive an annual stipend of $500 to help cover these expenses. Applicants to the program must meet
the following eligibility criteria:
• Applicants (patients) must be US citizens or permanent residents; and
• Applicants must have a confirmed blood cancer diagnosis; and
• Applicants must meet financial eligibility criteria defined as an annual household income at or
below 500% of the Federal Poverty Level.
LLS regularly receives calls from patients in crisis who cannot move forward with potentially life-saving
treatments because they cannot afford to pay for transportation to get to their providers, e.g., doctors,
hospitals, transplant centers, and research or clinical trial centers. As patients increasingly need to
travel to see a specialist for treatment, follow-up, or special tests to make the most of their chance to
fight for life, these costs and burdens are only increasing. Some patients have no transplant center in
their area are faced with the challenges of traveling to a treatment center and residing far from home for

an extended period of time. This is especially true for patients in rural areas. Other patients cannot take
public transportation due to their state of health. Travel costs to get to numerous appointments over
weeks, months or years is a great burden. Regardless of geography, the out-of-pocket costs associated
with traveling for care are prohibitive for many patients and reduces the funds available for basic needs
such as food, shelter and utilities.
If transportation/lodging needs are not met, issues with compliance and adherence to treatment
regimens arise, which can affect survival outcomes for blood cancer patients. Furthermore, travel
obstacles can have a direct impact on clinical trial enrollment. LLS has received numerous reports from
our LLS-funded investigators stating that transportation challenges prevent appropriate candidates from
enrolling in clinical trials.
The proposed project would cover the area of healthcare priority funding for the Ft. McDowell Yavapai
Nation. Within the healthcare umbrella, the project addresses direct patient care and assisting in
improving overall health of participants and community of Arizona. There will be an estimated 33,000
new cases of blood cancer in Arizona this year. Blood cancers occur in individuals of all ages and
gender. There are very few known causes of blood cancers and no opportunities for prevention or early
detection.
Many families faced with a cancer diagnosis are faced with difficult decisions regarding personal
budgets, family needs, and treatment. In many cases, having a family member undergoing treatment
for leukemia or lymphoma requires a parent, spouse or partner to miss frequent days of work, creating
even more economic stress. The Arizona Patient Travel Assistance Program would alleviate some of
this financial burden by providing financial assistance to help cover costs incurred in traveling to and
from treatments. The program helps to reduce a financial barrier to care and allows patients the access
to the treatments needed.
Our Patient Services Manager assists patients and their families through these overwhelming and
difficult circumstances resulting from a blood cancer diagnosis. This project would serve approximately
50 Arizona families with stipends of $500 based on application information. At this point, there are not
any additional funders participating. However, an application for assistance has also been submitted to
Gila River Communities and an application of intent made to Tohono O’odham Nation, and other
funders, including individuals and foundations, will be approached in the coming months to launch this
new program.
A time table for implementation of our program is as follows:
February 2015: Develop fundraising and program plan for upcoming fiscal year. Start to submit letters
of inquiry.
September 2015: Begin the program- evaluate applications from patients grant funds as needed.
October 2015: Patient services director to speak with hospitals, healthcare providers, and social
workers to evaluate the need for transportation and evaluate progress.
January 2016-May 2016: Continual application process and re-evaluate monthly end of month
June 2016: Final evaluation of entire program and assess its overall effectiveness within the
community
*dates dependent on grant funding stipulations and implementation
Serving patients in need requires support from generous donors. LLS is actively seeking funding for the
Travel Assistance Program from national and local supporters in order to sustain and grow this critical
patient program. A gift of $25,000 from the Ft. McDowell Yavapai Nation will enable LLS to provide
travel assistance to 50 Arizona families, making a significant and direct impact on their lives.
Thank you kindly for your consideration.

Sincerely,
Jim Brewer
Executive Director
Arizona Chapter

Patient Travel Assistance Program
Proposed Budget
Proposed budget Expense Amount Requested from Ft. Amount Requested from other Total
McDowell funders Budget
Patient Financial Aid for $25,000 $175,000 $200,000
Transportation
Total Budget $25,000 $175,000 $200,000
Attachment 1